Author(s)
Manki Chung, MD
Ji-Eun Choi, MD
Heejeong Kim, MD
Affiliation(s)
Samsung medical center
Abstract:
Objectives: The aim of this study is to present treatment outcomes and prognostic factors of surgical managements of locally advanced well-differentiated thyroid cancer. Methods: By retrospective analysis, 70 patients with T4a stage were enrolled from 1995 to 2016 in a single institution. Overall survival rate and locoregional recurrence-free probability were investigated as treatment outcomes, and clinicopathologic characteristics were analyzed to investigate prognosticators for recurrence. Results: The mean age of patients was 56.5 years, and 61.4% were female. The most commonly involved structure was recurrent laryngeal nerve (n=35), followed by the trachea (n=34), the larynx (n=10), and the esophagus (n=5). At the mean follow-up of 81.7 months, the 5-year disease-specific survival rate was 92.3%, and locoregional recurrence rate was 28.7%. By univariate analysis, microscopic clearance of tumor (R0 or R1) was not associated with increased risk of recurrence; on the contrary, advanced age, involvement of recurrent laryngeal nerve, increased tumor size, and higher level of stimulated serum thyroglobulin level at preablation and postablation state were associated with higher rate of locoregional recurrence. By univariate analysis, lateral node dissection was the prognostic factor for decreased rate of locoregional recurrence (hazard ratio 0.08, 95% confidence interval 0.01-0.48, p=0.006). Conclusions: Operative management followed by proper adjuvant therapy for locally advanced, differentiated thyroid cancer can achieve acceptable outcomes, regardless of the type of organs involved or R status. In addition, further studies to modify neck management strategy are needed.